Effects of oral fenugreek-derived preparations on testosterone-related outcomes in adult men: a systematic review and meta-analysis of randomized placebo-controlled trials.

BACKGROUND: Fenugreek (Trigonella foenum-graecum)-derived preparations are widely marketed for male-health benefits related to testosterone, sexual function, body composition, and exercise performance, yet the certainty, target population, and clinical interpretability of the available randomized evidence remain unclear. OBJECTIVE: To systematically evaluate the effects of oral fenugreek-derived preparations on testosterone-axis outcomes in adult men and to descriptively summarize related male-health outcomes, including sexual function, symptoms, body composition, exercise performance, and safety. METHODS: We included randomized placebo-controlled trials in adult men that evaluated oral fenugreek-derived preparations. Two authors independently searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 11, 2026, and additionally searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) for unpublished or grey evidence. Total testosterone and free testosterone were the primary outcomes. Risk of bias was assessed with the Cochrane Risk of Bias 2 (RoB 2) tool, certainty of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and the main pooled estimates were synthesized as standardized mean differences (SMDs) using random-effects models with restricted maximum likelihood (REML) estimation. RESULTS: Thirteen studies were included, of which eight reported primary testosterone-axis data and five provided related or contextual male-health evidence. Six studies contributed to the total-testosterone meta-analysis, which showed a small favorable association with fenugreek (SMD: 0.25, 95% CI: 0.02, 0.48; p = 0.037; I2 = 0%, p = 0.578). Five studies contributed to the free-testosterone meta-analysis, for which the pooled estimate was imprecise and heterogeneous (SMD: 0.08, 95% CI: -0.48, 0.63; p = 0.725; I2 = 66.7%, p = 0.023). Across all 13 included studies, 11 were judged as having some concerns and 2 as high risk of bias; none was judged as low risk overall. The certainty of evidence for both primary testosterone-axis outcomes was very low. CONCLUSION: Oral fenugreek-derived preparations may be associated with a small favorable standardized effect on total testosterone in adult men, but the evidence is very uncertain and does not demonstrate a stable free-testosterone benefit. Current evidence does not support clinical or commercial testosterone-boosting claims. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD420261364708. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261364708.